title: Protocol for a randomised blocked design study using telephone and text-messaging to support cardiac patients with diabetes: a cross cultural international collaborative project.
abstract: BACKGROUND
  The prevalence of type 2 diabetes is rising internationally. Patients with diabetes have a higher risk of cardiovascular events accounting for substantial premature morbidity and mortality, and health care expenditure. Given healthcare workforce limitations, there is a need to improve interventions that promote positive self-management behaviours that enable patients to manage their chronic conditions effectively, across different cultural contexts. Previous studies have evaluated the feasibility of including telephone and Short Message Service (SMS) follow up in chronic disease self-management programs, but only for single diseases or in one specific population. Therefore, the aim of this study is to evaluate the feasibility and short-term efficacy of incorporating telephone and text messaging to support the care of patients with diabetes and cardiac disease, in Australia and in Taiwan.
  
  
  METHODS
  A randomised controlled trial design will be used to evaluate a self-management program for people with diabetes and cardiac disease that incorporates the use of simple remote-access communication technologies. A sample size of 180 participants from Australia and Taiwan will be recruited and randomised in a one-to-one ratio to receive either the intervention in addition to usual care (intervention) or usual care alone (control). The intervention will consist of in-hospital education as well as follow up utilising personal telephone calls and SMS reminders. Primary short term outcomes of interest include self-care behaviours and self-efficacy assessed at baseline and four weeks.
  
  
  CONCLUSIONS
  If the results of this investigation substantiate the feasibility and efficacy of the telephone and SMS intervention for promoting self management among patients with diabetes and cardiac disease in Australia and Taiwan, it will support the external validity of the intervention. It is anticipated that empirical data from this investigation will provide valuable information to inform future international collaborations, while providing a platform for further enhancements of the program, which has potential to benefit patients internationally.
  
  
  BACKGROUND
  ACTRN 12611001196932.
authors.affiliation: School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia. c3.wu@qut.edu.au.
authors.forename: Chiung-Jung Jo
authors.initials: CJ
authors.lastname: Wu
authors.forename: Huei-Chuan
authors.initials: HC
authors.lastname: Sung
authors.forename: Anne M
authors.initials: AM
authors.lastname: Chang
authors.forename: John
authors.initials: J
authors.lastname: Atherton
authors.forename: Karam
authors.initials: K
authors.lastname: Kostner
authors.forename: Mary
authors.initials: M
authors.lastname: Courtney
authors.forename: Steven M
authors.initials: SM
authors.lastname: McPhail
mesh_terms: D000328:Adult; D001315:Australia; D003299:Cooperative Behavior; D003431:Cross-Cultural Comparison; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D006331:Heart Diseases / Q000150:complications* / Q000628:therapy; D006801:Humans; D007391:International Cooperation; D017010:Reminder Systems; D012648:Self Care / Q000295:instrumentation / Q000379:methods*; D013624:Taiwan; D013689:Telephone; D060145:Text Messaging